Provider Demographics
NPI:1548522436
Name:CROCKETT, LADY (MSN, APRN-CNP, PMHNP)
Entity type:Individual
Prefix:MRS
First Name:LADY
Middle Name:
Last Name:CROCKETT
Suffix:
Gender:F
Credentials:MSN, APRN-CNP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6942 TYLERSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-1511
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3239 JEFFERSON AVE STE 1PMB1010
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45220-2270
Practice Address - Country:US
Practice Address - Phone:513-790-4367
Practice Address - Fax:513-572-7142
Is Sole Proprietor?:No
Enumeration Date:2012-06-15
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH384621163W00000X
OH0029189363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse